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situations, medical supervision is typically provided, including individualized diet instruction (IOM, 2000), and a potassium intake below the AI is often appropriate. For individuals with these diseases or clinical conditions, salt substitutes (containing potassium chloride) should be used cautiously. While adverse events following high potassium consumption usually do not occur in these special populations, there are case studies cited in the literature indicating that these groups are vulnerable (see Table 5-13).

RESEARCH RECOMMENDATIONS

  • Dose-response trials testing the effects of different levels of potassium intake on blood pressure at different levels of sodium intake.

  • Additional dose-response trials evaluating the effect of potassium on salt sensitivity in subgroups of the population that are salt sensitive (e.g., African Americans, older persons, and persons with hypertension, chronic kidney disease, or diabetes).

  • Randomized clinical trials to compare the effect of different potassium salts on blood pressure and other outcomes at different levels of sodium intake.

  • Development of improved measurements and instruments that assess total potassium intake and total body potassium.

  • Trials that test the efficacy of increased potassium intake on preventing stroke.

  • Trials that test the main and interactive effects of potassium and sodium intake on bone mineral density and, if feasible, bone fractures.

  • Trials testing the main and interactive effects of sodium and potassium intake on the risk of kidney stones.

  • Studies to assess the main and interactive effects of potassium and sodium intake on glucose intolerance and insulin resistance.

  • Studies on the role of potassium intake during infancy and childhood on blood pressure later in life.

  • Potassium balance studies during pregnancy.

  • Better estimates of potassium losses in sweat with various dietary, activity, and environmental conditions in diverse populations.

  • Development of food tables for citrate and bicarbonate.

  • Studies on the effects of chronic, low-grade metabolic acidosis on clinical outcomes, particularly kidney stones and osteoporosis.

  • Trials to assess the effects of high potassium intake on serum potassium levels and blood pressure in the setting of early stages of renal insufficiency (with and without ACE inhibitor therapy).



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